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Evaluation and Monitoring During Treatment of Latent
Tuberculosis Infection (LTBI)
All patients should have the following:
• An initial pre-treatment clinical evaluation to rule out active TB disease and to assess for the
likelihood of adverse effects of therapy
• Rule out pregnancy prior to starting isoniazid-rifapentine (INH-RPT) regimen
• Voluntary HIV counseling and testing
• Education about adverse effects associated with treatment of LTBI, with advise to stop
treatment and promptly seek medical evaluation if serious adverse effects occur
• A follow-up evaluation at least monthly, including careful questioning and a brief physical
examination to assess for evidence of hepatitis or other adverse effects, symptoms of active TB
disease, and adherence to the regimen. Patients receiving the INH-RPT regimen should have a
monthly physical exam to assess for the presence of jaundice, liver tenderness, and rash.
See Treatment for Latent Tuberculosis Infection (LTBI): Monitoring Flow Sheet at
www.health.state.mn.us/divs/idepc/diseases/tb/flowsht.pdf for further assistance with this process.
Laboratory testing is not routinely recommended.
Indications for baseline LFTs, including serum bilirubin and either AST (SGOT) or ALT
(SGPT):
• Foreign-born from areas where viral hepatitis is endemic and for whom complete hepatitis
serology results are unknown
• HIV infection
• Pregnancy or ≤ 3 months postpartum
• History or initial evaluation indicative of hepatitis or cirrhosis
• Regular alcohol use
Indications for monthly LFTs, including serum bilirubin and either AST (SGOT) or ALT
(SGPT):
• Abnormal baseline LFTs
• Chronic liver disease
• Regular alcohol use
Medication should be withheld and patient evaluated promptly if:
• Transaminase levels > 3 times upper limit of normal in persons with symptoms of hepatitis
• Transaminase levels > 5 times upper limit of normal in asymptomatic persons
• If patient becomes pregnant while receiving INH-RPT, discontinue regimen
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Adapted by the Minnesota Department of Health from materials developed by the Charles P. Felton National
Tuberculosis Center at Harlem Hospital, New York, NY.
Centers for Disease Control and Prevention. Recommendations for the Use of an Isoniazid-Rifapentine
Regimen with Direct Observation to Treat Latent Mycobacterium tuberculosis Infection. MMWR
2011;60:1650-1653.
Tuberculosis (TB) Prevention and Control Program
P.O. Box 64975, St. Paul, MN 55164-0975
Phone: (651) 201-5414 Fax: (651) 201-5500
Revised, May 2012